Interview Dr. Egozcue
When we talk about fertility, the focus is often on the woman, but the reproductive health of the man is a determining factor in the success of a pregnancy. Although the semen analysis is the most common test to assess semen quality, in many cases it is not enough to obtain a complete diagnosis. Sperm DNA fragmentation, sperm morphology and their role in embryonic development are key aspects that can influence the probability of achieving an evolutionary pregnancy.
To delve into these topics, we have the experience of Dr. Susana Egozcue, andrologist and male fertility specialist, who will explain what factors can affect sperm quality, how to evaluate them and what options exist to improve reproductive health in men.
1. Is the semen analysis sufficient to assess male fertility or what other tests may be needed?
The semen analysis is not enough to evaluate male fertility. It gives us initial information about the quality of the semen, but it is very important to make a good andrological assessment in which we will delve into the personal, family, reproductive history of the couple as well as a physical examination that will help us determine if we need complementary studies (hormonal analysis, FISH study, Fragmentation, Meiosis, Seminal culture....) and which are appropriate for each patient. The semen analysis does not say whether a man is fertile or not, it is a specific piece of information.
2. What are the most common causes of male infertility and what treatments are there?
There are multiple causes. One of the most common is low seminal quality, either in concentration (number of sperm), motility or morphology (shape of the sperm), which are often combined. In these cases, it is necessary to go deeper as it can be associated with other added causes such as: genetic factors, seminal infections, hormonal alterations, bad lifestyle habits, taking certain medications,.... That is why it is so important that the andrologist visits you.
Depending on the causes and the results we obtain, we will be able to advise which treatment is the most appropriate in each case. For example: if there is an infection, we will treat with the corresponding antibiotic; if there are toxic factors, we will indicate reducing or eliminating them; if they are hormonal causes, we will give the appropriate treatment to regulate it,...
We must be very clear that there is no man equal to another, there is no woman equal to another and therefore there is no partner equal to another, that is why it is so important to personalize each couple to determine what you try and which path is the most appropriate in each case.
3. What impact does sperm DNA fragmentation have on fertility and how is it evaluated?
Sperm DNA fragmentation refers to the breakage or damage to the DNA inside the head of sperm.
Sperm DNA fragmentation is caused by multiple factors: pollution, diet, stress, varicocele, smoking, drugs, fever, caffeine,.... and if it is high, it can be related to not achieving a pregnancy spontaneously or with fertilization failure, poor evolution of the embryos and abortions in ART (Assisted Reproduction Treatments).
It can be evaluated with different techniques: SCD Test, Tunnel Test and Comet which is the one we usually request. This evaluates single-strand fragmentation, which is the one that can be repaired more with antioxidants, and double-stranded fragmentation, which is less repairable and which leads to further studies such as FISH in spermatozoa.
If the fragmentation is altered, we will indicate the intake of antioxidants, modify toxic habits if they exist and in case of starting ART, indicate applying the Zymoy/Fertilechip/Microfluidics technique to be able to select the spermatozoa with better motility, better morphology and less fragmentation.
4. What role does sperm play in the development of the embryo beyond fertilization?
It plays an important role: on the one hand, once the sperm has penetrated the egg, the membranes fuse and the entry of factors called SOAF (Spermborne Oocyte Activating Factors) occurs, which, by modulating the concentration of calcium ions, communicate to the egg that it has been fertilized and activate it to start the process of cell division.
On the other hand, the integrity of the sperm DNA and, as we have already mentioned, its fragmentation, are crucial in the fertilization and evolution of the embryo.
In addition, the chromosomal content of the sperm (23 Cr) that will form the male pronucleus will fuse with the female pronucleus (23Cr) to give rise to the Zygote (46Cr). If this content is altered (it has > or < of 23 Cr) it will lead to a genetically incorrect embryo and depending on the number of chromosomes involved we can have situations such as: fertilization failure, embryo blockage, non-gestation or repeated miscarriages.
Sperm also provide epigenetic marks that can influence the expression of certain genes during embryonic development. In short, the sperm has a crucial role in both fertilization and the evolution of the embryo.
5. What habits or treatments can improve sperm quality?
As for habits: healthy diet, moderate sport, avoid toxins such as tobacco, alcohol, drugs, if you work with toxins use sunscreens, low caffeine consumption, sleep well, reduce stress,....
In terms of treatments, it will depend on whether we have more or less associated causes. For example:
- Antibiotic treatment if there is a seminal infection.
- Varicocelectomy, depending on the reproductive history and age of the couple.
- Hormone treatment
- Integrate antioxidants such as omega3, Coenzyme Q10, selenium, zinc, turmeric, vitamin D, B... always without overdosing.
We must not create false expectations and clarify that all this helps to try to improve the quality in quantity, mobility, morphology and reduce fragmentation and that this is not always achieved since depending on the cause of low seminal quality, the effects may be greater or less.
Male fertility is a field in constant evolution, and an in-depth understanding of the factors that influence it is key to improving success rates in assisted reproduction treatments. We thank Dr. Susana Egozcue for sharing her knowledge and helping us better understand how to approach male infertility with a comprehensive and personalized approach. At Barcelona IVF , we remain committed to offering the best solutions for those who seek to fulfill their desire to become parents.
